title: Travelers' diarrhea in Nepal: an update on the pathogens and antibiotic resistance.
abstract: BACKGROUND
  Diarrhea is the most common illness among travelers and expatriates in Nepal. Published data on the etiology of travelers' diarrhea (TD) in Nepal are over 13 years old and no prior data exist on antibiotic susceptibility for currently used drugs. We investigated the etiology of diarrhea and antimicrobial susceptibility pattern of bacterial pathogens and compared the results to previous work from the same clinical setting.
  
  
  METHODS
  A total of 381 cases and 176 controls were enrolled between March 2001 and 2003 in a case-control study. Enrollees were over age 18 years from high socioeconomic countries visiting or living in Nepal. Stool samples were assessed by microbiologic, molecular identification, and enzyme immunoassay (EIA) methods, and antimicrobial susceptibility was determined by disk diffusion. Risk factors were assessed by questionnaires.
  
  
  RESULTS
  At least one enteropathogen was identified in 263 of 381 (69%) cases and 47 of 176 (27%) controls (p ≤ 0.001). Pathogens significantly detected among cases were Campylobacter (17%), enterotoxigenic Escherichia coli (ETEC) (15%), Shigella (13%), and Giardia (11%). Cyclospora was detected only in cases (8%) mainly during monsoon season. Although 71% of Campylobacter isolates were resistant to ciprofloxacin, 80% of bacterial isolates overall were sensitive to either ciprofloxacin or azithromycin while 20% were intermediately sensitive or resistant. No bacterial isolates were resistant to both drugs.
  
  
  CONCLUSIONS
  The most common pathogens causing TD in Nepal were Campylobacter, ETEC, and Shigella. Because resistance to fluoroquinolone or azithromycin was similar, one of these drugs could be used as empiric therapy for TD with the other reserved for treatment failures.
authors.affiliation: The CIWEC Clinic Travel Medicine Center, Kathmandu, Nepal. pandey@mos.com.np
authors.forename: Prativa
authors.initials: P
authors.lastname: Pandey
authors.forename: Ladaporn
authors.initials: L
authors.lastname: Bodhidatta
authors.forename: Michael
authors.initials: M
authors.lastname: Lewis
authors.forename: Holly
authors.initials: H
authors.lastname: Murphy
authors.forename: David R
authors.initials: DR
authors.lastname: Shlim
authors.forename: William
authors.initials: W
authors.lastname: Cave
authors.forename: Ramachandran
authors.initials: R
authors.lastname: Rajah
authors.forename: Martin
authors.initials: M
authors.lastname: Springer
authors.forename: Trish
authors.initials: T
authors.lastname: Batchelor
authors.forename: Siriporn
authors.initials: S
authors.lastname: Sornsakrin
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Mason
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002167:Campylobacter / Q000472:pathogenicity; D016022:Case-Control Studies; D021744:Cyclospora / Q000472:pathogenicity; D019049:Developed Countries; D003967:Diarrhea / Q000175:diagnosis* / Q000188:drug therapy*; D004352:Drug Resistance, Microbial; D054307:Enterotoxigenic Escherichia coli / Q000472:pathogenicity; D005260:Female; D005872:Giardia / Q000472:pathogenicity; D006090:Gram-Negative Bacteria / Q000302:isolation & purification / Q000472:pathogenicity*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009390:Nepal; D012760:Shigella / Q000472:pathogenicity; D014195:Travel; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents